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Implementing the Orebro Musculoskeletal Pain Screening Questionnaire in Clinical Practice

By Luke McManus | 20th June 2019 | Clinical Development

This is a follow-up article to a recent publication in the Australian Physiotherapy Association (APA) magazine ‘In Touch’ in May 2019.

This APA article summarised the results of a study that looked at how educating and implementing the Orebro Musculoskeletal Pain Screening Questionnaire (OMPSQ-10) can significantly change behaviour in the use of this screening tool in private practice settings.

A summary of organisational factors:

  • The OMPSQ-10 can be accessed here
  • A digital version of the OMPSQ-10 can be found on the painHEALTH website here (2)
  • It’s helpful to include the OMPSQ-10 as part of the initial paperwork for patients on their first physiotherapy consultation
  • The patient doesn’t need to add up their score, as this can reduce accidental errors in scoring

Interpreting the OMPSQ-10 score

As mentioned in Linton et al (2011) article on the development of the OMPSQ-10, scores greater than 50/100 are considered high risk in terms of prediction of chronicity and longer-term work absence [1].

The ten questions are also five broad categories, which are [1]:

  • Pain - Q1 and Q2
  • Self-perceived function - Q3 and Q4
  • Distress - Q5 and Q6
  • Return to work expectancy - Q7 and Q8
  • Fear-avoidance behaviour - Q9 and Q10

These five categories can also be monitored over time with repeat OMPSQ-10 assessments, to observe any changes in these areas as well as with the total score.

Usefulness in Clinical Practice

The OMPSQ-10 is a useful questionnaire to objectively measure a patient’s risk of long-term work absence and chronicity [1].

In my experience, the OMPSQ-10 has been helpful in exploring each sub-category below and can guide follow up questions in a subjective examination.

Pain (Q1-2)

The first question is a measurement of time, so this will naturally increase the longer it has been since the onset of symptoms.

The second question is using a visual analogue scale (VAS) to measure their average pain over the last week.

If you repeat the OMPSQ-10 in 4-6 week intervals, you might find trends and patterns in their VAS that might link in with other variables such as physical load, distress, sleep patterns or other factors relevant to the patient.

Self-Perceived Function (Q3-4)

The third and fourth questions look at the patient's view of their general level of function.

Monitoring over time a patient's view of how well they can perform light work for an hour can be pretty insightful, both for reinforcing positive progress, as well as gently challenging an increase in their activity levels as appropriate.

The fourth question regarding sleep is also key.

Patients will sometimes look over this as a non-specific question, but if sleep is being recorded as a challenge, it's good to chat more about this:

  • Has this been a recent change in sleep pattern?
  • Are they having trouble initially getting to sleep?
  • Are they falling asleep, but waking regularly throughout the night?
  • Are they feeling rested once they wake up in the morning?

Sleep is a big topic in itself, and more can be discussed here.

Distress (Q5-6)

We know as physiotherapists that anxiety and depression can be highly influential on a patient's experience of musculoskeletal pain and their course of recovery.

The close relationships we develop with our patients often provide a safe environment for patients to share their feelings and emotions regarding their pain.

We don't need to be experts at dealing with distress, but it's good to be aware of whether this might be an important part of a patient's current experience.

Sometimes patients can experience an increase in anxiety that is associated with not understanding their recent musculoskeletal pain, and simply discussing their diagnosis and management options, can feel empowering and relieving.

For patients who have experienced more long-term distress, physiotherapists can still provide a safe space for the patient to discuss anything they feel comfortable with and can help them look into available options for more skilled assessment and help with their distress.

This could be chatting to their GP and discussing if any formal counselling or psychological help might be helpful.

Return to Work Expectancy (Q7-8)

Questions 7 and 8 can be good to monitor over time as an indication of the patient's beliefs around their prognosis and recovery timeframes.

These questions can be helpful to raise if the patient's beliefs are perhaps more self-limiting than they are demonstrating in their clinical examination.

Conversely, a patient may have an unrealistic expectation about their estimated recovery time frames and plan for returning to work.

Fear Avoidance Behaviours (Q9-10)

The OMPSQ-10 also looks into fear-avoidance behaviours.

It is known that fear can contribute to movement behaviours that may be an actual barrier to their recovery.

The good news is that these can often be simply modified with education, demonstration and graded exposure to help the patient regain confidence in normal, healthy movement.

Summary

  • Setting up a system is important to improve the habit of using screening tools (e.g., having the OMPSQ-10 as part of the patient's initial paperwork)
  • It is helpful to monitor both the overall score as well as the scores of each category over time
  • Screening tools may not be perfect, but they can be really helpful as a part of a broader clinical examination for physiotherapists.

References

  1. Linton SJ, Nicholas M, MacDonald S. Development of a short form of the Orebro Musculoskeletal Pain Screening Questionnaire. Spine. 2011;36(22):1891–1895.
  2. PainHealth website

Luke McManus

Luke is Musculoskeletal Physiotherapist from Perth, Australia. He created Physio Development to help physiotherapists identify their unique career pathway and to enjoy a long and successful career in physiotherapy.

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